An NHS funding rise of just 0.1% in real terms for 2015/16 and demand rising at 4% a year mean efficiency savings will need to go well beyond the £20bn Nicholson challenge, according to Jon Ford, head of the BMA’s health policy and economic research unit.

Writing in the BMJ, Mr Ford argues that it is ‘totally unrealistic’ to suggest that these savings can be found from cuts to staff and pay – the principal source of £5.8bn efficiencies reported for 2011/12.

Although the DH has reported it is on track to meet the Nicholson target, Mr Ford says that if staff and pay are targeted again ‘the scale of the savings that need to be found would require pay and staffing levels to be decimated, creating safety and workforce problems that would simply make the service unviable’.

Mr Ford adds: ‘Already, doctors are citing relentless demand as the biggest reason they cannot make the improvements to patient care that are needed.

‘The NHS is facing a deepening financial crisis. The recent comprehensive spending review must serve as a wake-up call.’